Hospitals want CMS to correct MA plan policies on coverage

Published: Thu, 11/30/23

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Hospitals want CMS to correct MA plan policies on coverage

The American Hospital Association is asking the Centers for Medicare and Medicaid Services to crack down on Medicare Advantage insurers it says are blatantly flaunting CMS coverage rules.

United Healthcare’s Medicare Advantage and the Two-Midnight Rule

Well, I suppose I have given you enough of a break from my writing about Medicare Advantage (MA) plans and the Two-Midnight Rule. Last week, United HealthCare (UHC) released its coverage summary for hospital care for patients with UHC Medicare Advantage.

Beware: Recent Changes to MDS Could Cause Audits

Recent changes to the minimum data set (MDS) assessment and recent audit activity targeting skilled nursing facilities (SNFs) appear to be an emerging issue. As a reminder, the MDS assessment is a standardized assessment used in SNFs and some swing-bed facilities to capture administrative and...

Feds propose rule changes for No Surprises Act

Federal policy makers aim to revise the billing dispute resolution process in the No Surprises Act (NSA). The administration of President Joe Biden and the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the U.S. Centers for Medicare & Medicaid Services (CMS) announced a draft rule to change the independent dispute...

CMS Says Post-Acute Care Choice Only Goes So Far

Access to post-acute care remains an issue in most hospitals around the country. Exacerbated by the staffing challenges that worsened during COVID-19, the ability to get a patient transferred to a skilled nursing facility (SNF) in a timely manner is rare. That creates several issues....

Staying Current with Medical Necessity

A new quarter began on Oct. 1, an event that usually brings updates to National Coverage Determinations (NCDs). The coding updates included for Oct. 1 are specified in Change Request (CR) 13166, which is a maintenance update. This document is mentioned in the MLN Connects published Sept. 28.

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